Healthcare Provider Details

I. General information

NPI: 1306884861
Provider Name (Legal Business Name): FLORIDA INSTITUTE FOR CARDIOVASCULAR CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21097 NE 27 CT SUITE 110
AVENTURA FL
33180-1206
US

IV. Provider business mailing address

2905 N COMMERCE PKWY
MIRAMAR FL
33025-3957
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-8813
  • Fax: 305-682-8623
Mailing address:
  • Phone: 954-967-6550
  • Fax: 954-962-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: BRIAN POLNER
Title or Position: OWNER
Credential: M.D.
Phone: 954-430-3866